Alcohol abuse increased one city’s EMS costs by millions of dollars a year

By Karen N. Peart

August 6, 2014

So-called “superusers” of Emergency Medical Services (EMS) — most of whom had alcohol-related reasons for their EMS transport — generated millions of dollars in medical costs in one year alone in the city of San Francisco, according to a new study from Yale School of Medicine and the University of California-San Francisco (UCSF).

The detailed study, which focuses on the financial impact of alcohol abuse on one urban community, appears in the journal Prehospital Emergency Care.

Researchers from the Emergency Department at Yale and the UCSF identified 100 EMS superusers — individuals who used EMS services in San Francisco more than 15 times in the year 2009. The data was collected in collaboration with the San Francisco Fire Department.

In the study, Yale first author M. Kennedy Hall and colleagues found that superusers were significantly younger and more likely to be male than other EMS users. The majority of superusers had Medicaid coverage. Furthermore, superusers were more than eight times more likely to have an alcohol-associated reason for an EMS encounter than people who used EMS only once that year.

Although the EMS superuser group comprised only 0.3% of the total number of individuals who used EMS, they generated 6.1% of the transports, as well as a disproportionate share of estimated charges — $3.8 million for that year — reimbursed primarily through public insurance programs.

“The frequency of alcohol use by EMS superusers is an astounding statistic and drives home the degree to which alcohol impacts EMS use and strains the emergency care workforce,” said Hall, instructor of emergency medicine at Yale School of Medicine. “Given that millions of dollars in taxpayer funds are being spent on this vulnerable patient population, our findings demonstrate the need to develop targeted interventions to improve care coordination for these superusers.”

Other authors are Jane Hall of Yale; Maria Raven, Clement Yeh, Elaine Allen, Robert Rodriguez, Karl Sporer, and John Brown of UCSF; and Niels Tangherlini of the San Francisco Fire Department.

The study was supported by the UCSF Clinical and Translational Science Institute Resident Research Funding Program.